Evidence Of Graft Resorption Research Articles

Reverse shoulder arthroplasty vs BIO-RSA: clinical and radiographic outcomes at short term follow-up

BackgroundBony increased-offset reverse shoulder arthroplasty (BIO-RSA) may address issues such as inferior scapular notching, prosthetic instability and limited postoperative shoulder rotation; all of which have been reported with the standard RSA and attributed to the medialized design. We hypothesised that this lateralization may increase the rate of scapular stress fractures.MethodsA retrospective review of prospectively collected data was performed on patients who had undergone a RSA between January 2013 and October 2016. A comparative cohort study was designed to compare patients with a standard Grammont-style RSA to those with a BIO-RSA using the same implant. Functional outcome was measured by the American Shoulder and Elbow Surgeons (ASES) Shoulder Score, the Subjective Shoulder Value (SSV), the Western Ontario Osteoarthritis of the Shoulder (WOOS) index and pain scores. Radiographs were obtained for all patients and examined for the presence of scapular fracture as well as scapular notching and graft incorporation.ResultsA total of forty patients (22 patients in the standard RSA cohort and 18 with BIO-RSA) were included in the study. Patient characteristics (including age, gender, length of follow-up, dominant side and osteoporosis) were similar in both groups (p > 0.05). The average postoperative follow-up was 20 months (range 12–48 months). There was bone graft incorporation in all BIO-RSA patients at the final radiological follow-up, with no evidence of graft resorption. The overall scapular stress fracture rate was 12.5% (9.1% in the standard RSA and 16.7% in the BIO-RSA). The rates were similar in both cohorts (p = 0.64). All fractures were managed conservatively. To determine whether the presence of a scapular stress fracture had an influence on outcomes, the cohort was divided into cases with and without fracture. Patients with a stress fracture had worse ASES (p = 0.028) and WOOS (p = 0.048) scores. Additionally, osteoporosis was present more commonly in the fracture group (80% vs 17%; p = 0.01). A statistically significant difference was identified when comparing the rates of scapular notching between standard RSA and BIO-RSA cohorts (68% vs 33%; p = 0.028). Furthermore, when notching was present, significantly worse outcome scores were present in all outcome measures (p < 0.001).ConclusionThe BIO-RSA technique was associated with an increase in scapular stress fracture rate when compared to the standard RSA; however, this was not found to be significant. Furthermore, both techniques resulted in similar improvements in the measured functional outcomes. BIO-RSA, however, was associated with a lower scapular notching rate, justifying further evaluation of this technique.Level of evidenceRetrospective cohort study, level III

Efficacy of diced cartilage graft in dorsal augmentation rhinoplasty and comparison with solid block cartilage

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the study is to compare the results of dorsal augmentation rhinoplasty using diced cartilage graft wrapped in temporalis fascia and bare, solid block of cartilage.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study of a group of 25 patients who presented to ENT OPD from January 2011 to January 2016 with saddle nose deformity. All the patients underwent external septorhinoplasty with dorsal augmentation using either diced cartilage wrapped in temporalis fascia or solid piece of cartilage harvested from septum or concha. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The patients were followed up for 18 months post-operatively and the results were recorded in terms of patient’s satisfaction. Complications, if any were also recorded.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Comparison between the two groups yielded equal success rate with no evidence of graft resorption, infection or extrusion in either of the group.&lt;/p&gt;

Use of β-tricalcium phosphate grafts for Airway reconstruction in rabbits: A pilot study

To assess the safety and feasibility of using β-tricalcium phosphate grafts in airway reconstruction in rabbits. Interventional animal study. Ten New Zealand White rabbits underwent division of the anterior cricoid cartilage with interposition of a graft sculpted from β-tricalcium phosphate blocks. Grafts were secured with sutures or were self-retaining. Rabbit larynges were harvested according to the following schedule: one at 1 week, one at 3 months, and two each at 2 weeks, 4 weeks, 6 months, and 1 year after graft implantation. Specimens were evaluated grossly for overall graft incorporation. Sections through the graft substance were prepared for histology. All sections were reviewed by a pathologist for evidence of vascular ingrowth, granulation tissue, inflammation, epithelialization, and graft resorption. There were no major postoperative complications. Gross examination revealed persistent widening of the airway at the level of graft placement. Histologic evaluation of the larynges showed growth of new blood vessels within all specimens and absence of significant granulation tissue near the airway lumen. The graft was at least partially covered by an epithelium in seven of the 10 specimens. Evidence of graft resorption was present as early as 4 weeks after implantation, with replacement of the graft substance by fibrous tissue, fatty tissue, bone, or cartilage. β-tricalcium phosphate grafts can be used safely in airway reconstruction procedures in rabbits. Further research is necessary to demonstrate its safety in human airway reconstruction in addition to further clarifying the processes of graft resorption and integration. NA Laryngoscope, 126:E255-E260, 2016.

Massive heterotopic ossification associated with late deficits in posterior wall of acetabulum after failed acetabular fracture operation

BackgroundHeterotopic ossification is a common postoperative complication of acetabular fracture. However, functionally significant heterotopic ossification with associated late bone defects in the posterior wall of the acetabulum is rare and challenging to treat. When heterotopic ossification is a late complication of failed acetabular fracture operation, it is disabling and may only be treated by THA. THA is highly susceptible to premature failure in young and active patients and may require numerous revisions.Case presentationThis article describes a 40-year-old man with massive heterotopic ossification associated with late bone defects in the posterior wall of the acetabulum after a failed acetabular fracture operation. The primary fracture type was a 62-A2.3 fracture according to the AO/OTA Classification.Surgical excision and anatomical reconstruction of the acetabular wall using heterotopic ossific bone were performed 10 months after the fracture repair. Postoperatively, indomethacin was administered for prophylaxis against recurrence of heterotopic ossification, and hip range of motion was progressively increased. At 5 years and 6 months follow-up, the patient’s pain was relieved and hip function had recovered. Though radiography and CT showed minimal subchondral cysts and mild joint-space narrowing, there was no evidence of graft resorption, progressive posttraumatic osteoarthritis or necrosis of the femoral head.ConclusionTo the authors’ knowledge, this is the first case of such a challenging condition. Although it is an extremely rare case, it provides an attractive option for avoiding THA, as the long-term follow-up shows a satisfactory outcome.

Vancomycin-supplemented Cancellous Bone Allografts in Hip Revision Surgery

We explored the role of vancomycin-supplemented cancellous bone allografts in hip revision surgery. We evaluated the incorporation of these allografts in 18 pigs' radiographs, histology, and immunohistochemistry. High-quality radiographs, histologic examination, and immunologic expression of metalloproteinase-13 and transforming growth factor-beta 2 indicated vancomycin did not considerably affect bone graft incorporation. Elution, bioactivity, and nephrotoxicity were subsequently tested in 20 patients who underwent hip reconstruction with this method. Local active bactericidal levels of vancomycin reached 1400.5 microg/mL (average 5-point level, 367.19 microg/mL). Vancomycin was present in urine until day 15 without any sign of nephrotoxicity. Clinical analysis was performed in 30 patients whose hips underwent reconstruction with vancomycin-supplemented cancellous bone allograft. At a minimum 2-year followup, infection control was attained in 29 of 30 patients (reinfection rate, 3.3%; 95% confidence interval, 0.08-17%) without evidence of graft resorption. Histologic observations performed in two patients whose hips were reconstructed with this technique were similar to the ones reported in nonsupplemented bone allografts. Our findings encourage the continued use of vancomycin-supplemented bone allografts in reconstructive orthopaedic surgery.

Fresh-Frozen Structural Allografts in the Foot and Ankle

The purpose of this study was to review the results of using structural fresh-frozen femoral head allografts in foot and ankle procedures. These grafts were used in order to restore more normal dimensions of the foot and ankle following surgery or trauma and to treat arthritis or deformity in situations in which conventional cancellous graft would not be sufficient. Between January 1995 and December 1998, seventy-five foot and ankle operations were performed with use of structural allograft in seventy-three patients with an average age of forty-six years. The graft was used in conjunction with procedures such as arthrodesis of the subtalar joint (twenty-eight procedures) and osteotomy of the calcaneus (eleven procedures). Risk factors identified preoperatively included diabetes and neuropathy, smoking, osteonecrosis, and multiple previous operations. Each operation was performed in a standard manner, with rigid internal fixation. The mean structural dimension (height or length) of the graft was 1.85 cm. Healing was determined by the absence of swelling and warmth and by the presence of trabeculation across the arthrodesis or osteotomy site on both sides of the allograft as seen radiographically. Healing occurred, at a mean of 4.0 months, after 92% (sixty-nine) of the seventy-five procedures. Once the graft was integrated, there was no evidence of graft resorption or subsidence at a mean of 3.5 years postoperatively. Nine of the seventy-three patients had a superficial wound complication (dehiscence or infection), and a deep infection developed in two patients. Use of structural allografts is appropriate for reconstructive procedures in the foot and ankle. The grafts may be used successfully, with a relatively low complication rate, in patients with risk factors for less satisfactory bone-healing.

Free fat autotransplantation for the cosmetic treatment of first web space atrophy.

The results of free fat autotransplantation for the correction of first web space atrophy were reviewed for 25 patients who sustained war injuries resulting in ulnar nerve palsies. In anticipation of partial graft resorption, a 30% overcorrection of the first web space deformity was performed compared with the normal hand. Average follow-up was 5 years. All patients were satisfied with their cosmetic results. Whereas 21 patients (84%) demonstrated less bulk when compared to their normal side, 4 (16%) retained slight overcorrection of the web space. After 1 year of follow-up, there was no further evidence of graft resorption. There were no long-term complications. We conclude that free fat autotransplantation for the cosmetic correction of atrophy of the first web space is a safe and effective procedure. Although graft resorption was encountered, overcorrection provided patients with dramatic cosmetic improvement.